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Spending for Dental Care Since 1980: Smaller Pieces of a Growing Pie
SPENDING FOR DENTAL CARE IC E 1980:
S M A L L E R P IE C E S O F A C R O W IN G
P IE
J O H N E. B E N T L E Y
ore Americans than ever before are seeing the dentist. For 1986, The National Center for Health Statistics estim ates that 57.1 percent of the population over age 2 visited the dentist “within the last year,” up from 50.2 percent in 1979 and 55 percent in 1983. Between 1979 and 1986, the num ber of visits to the dentist increased 31.7 percent, from 354.4 million to 466.8 million visits. Spending for health care reaches a new high every year, as indicated by the Health Care Financing Adm inistration, which publishes annual estim ates of national health care expenditures. In 1989, the most recent year for which estim ates are available, total expenditures for health care grew to $604.1 billion. Of this am ount, $583.5 billion was spent on health services and supplies, and the balance went for research and construction. Spending for personal health care in 1989 totaled $530.7 billion. Expenditures for dental services accounted for $31.4 billion, about 5.9 percent. The $34.1 billion spent on dental care equals about $126 for each man, woman, and child in the United States in 1989 or about $225,000 for every professionally active dentist. It is also greater than the gross national product of 21 of the 62 countries listed in the 1990 Statistical A bstract of the United States. Spending for dental services increased significantly during the 1980s. Despite this growth, spending for dental services has not increased as fast as overall spending for health care. Personal health care spending increased over 143 percent between 1980 66
JADA, Vol. 122, November 1991
and 1989, from $218.3 billion to $530.7 billion. Dental expenditures, however, increased just 118 percent, from $14.4 billion to $31.4 billion during the same period. When looked at as percentage of personal health care spending, dental expenditures actually declined C H A R T
1
NATIONAL DENTAL EXPENDITURES
Source: Health Care Financing Administration
C H A R T
2
C H A R T
DENTAL SPENDING AS A PER CENTAGE OF TOTAL PERSONAL HEALTH CARE SPENDING
3
PER CAPITA NATIONAL DENTAL EXPENDITURES
IZ
LU
0 DC 111 a.
Calculated from data from the Health Care Financing Administration
0.7 percentage points, from 6.6 p ercen t to 5.9 percent. Dental spending as a percentage of all personal care expenditures either declined or rem ained constant each year betw een 1981 and 1989. W hen health care spending is adjusted for inflation and presented in constant 1982 dollars, the same patterns are seen. Personal health care expenditures grew from $265 billion in 1980 to $351.3 billion in 1989, an increase of 32.6 percent. Spending for dental services during the same period increased from 17 billion to 20 billion, an increase of only 17.6 percent. And as a percentage of total personal health care, dental spending still declined 0.7 percentage points, from 6.4 percent to 5.7 percent. Looked at from a per capita perspective, personal health care spending increased 122.6 percent, from $958 to $2,133, during the 68
JADA, Vol. 122, November 1991
C alcu lated fro m d a ta from th e H ealth C are F in a n cin g A d m in istra tio n
1980s. Per capita spending for dental services only just doubled in that period, from $63 to $126. When per capita dental expenditures are adjusted for inflation, spending stagnated during m ost of the 1980s. In constant dollars, per capita spending for dental care jum ped five dollars per person in 1981. Over the rem ainder of the decade, however, per capita spending increased less than one dollar, from $79.50 to $80.40; between 1981 and 1984 and again in 1989, per capita spending for dental care actually decreased. Per capita personal health care expenditures, in comparison, rose almost $249 during the 1980s, from $1,163 to $1,412, and increased $197 during the 1982-89 period. Although m ore people are seeing the dentist and the absolute num ber of dental visits has
increased dramatically, spending for dental care has not kept pace with total spending for personal health care. In effect, dental services are consum ing a progressively sm aller portion of a growing personal health care pie. This may be the logical outcome of recent trends in dentistry in the United States: during the 1980s, the general oral health of the nation improved, caries rates declined and dentists were spending a decreasing am ount of time on more expensive restora tive dentistry and an increasing am ount of time perform ing comparatively less expensive diagnostic and preventive procedures. ■ Mr. Bentley is research an aly st II, ADA Bureau of Econom ic a n d B ehavioral R esearch. Detailed expenditure tables a re available from Mr. Bentley.
S M A L L E R P IE C E S O F A C R O W IN G
P IE
J O H N E. B E N T L E Y
ore Americans than ever before are seeing the dentist. For 1986, The National Center for Health Statistics estim ates that 57.1 percent of the population over age 2 visited the dentist “within the last year,” up from 50.2 percent in 1979 and 55 percent in 1983. Between 1979 and 1986, the num ber of visits to the dentist increased 31.7 percent, from 354.4 million to 466.8 million visits. Spending for health care reaches a new high every year, as indicated by the Health Care Financing Adm inistration, which publishes annual estim ates of national health care expenditures. In 1989, the most recent year for which estim ates are available, total expenditures for health care grew to $604.1 billion. Of this am ount, $583.5 billion was spent on health services and supplies, and the balance went for research and construction. Spending for personal health care in 1989 totaled $530.7 billion. Expenditures for dental services accounted for $31.4 billion, about 5.9 percent. The $34.1 billion spent on dental care equals about $126 for each man, woman, and child in the United States in 1989 or about $225,000 for every professionally active dentist. It is also greater than the gross national product of 21 of the 62 countries listed in the 1990 Statistical A bstract of the United States. Spending for dental services increased significantly during the 1980s. Despite this growth, spending for dental services has not increased as fast as overall spending for health care. Personal health care spending increased over 143 percent between 1980 66
JADA, Vol. 122, November 1991
and 1989, from $218.3 billion to $530.7 billion. Dental expenditures, however, increased just 118 percent, from $14.4 billion to $31.4 billion during the same period. When looked at as percentage of personal health care spending, dental expenditures actually declined C H A R T
1
NATIONAL DENTAL EXPENDITURES
Source: Health Care Financing Administration
C H A R T
2
C H A R T
DENTAL SPENDING AS A PER CENTAGE OF TOTAL PERSONAL HEALTH CARE SPENDING
3
PER CAPITA NATIONAL DENTAL EXPENDITURES
IZ
LU
0 DC 111 a.
Calculated from data from the Health Care Financing Administration
0.7 percentage points, from 6.6 p ercen t to 5.9 percent. Dental spending as a percentage of all personal care expenditures either declined or rem ained constant each year betw een 1981 and 1989. W hen health care spending is adjusted for inflation and presented in constant 1982 dollars, the same patterns are seen. Personal health care expenditures grew from $265 billion in 1980 to $351.3 billion in 1989, an increase of 32.6 percent. Spending for dental services during the same period increased from 17 billion to 20 billion, an increase of only 17.6 percent. And as a percentage of total personal health care, dental spending still declined 0.7 percentage points, from 6.4 percent to 5.7 percent. Looked at from a per capita perspective, personal health care spending increased 122.6 percent, from $958 to $2,133, during the 68
JADA, Vol. 122, November 1991
C alcu lated fro m d a ta from th e H ealth C are F in a n cin g A d m in istra tio n
1980s. Per capita spending for dental services only just doubled in that period, from $63 to $126. When per capita dental expenditures are adjusted for inflation, spending stagnated during m ost of the 1980s. In constant dollars, per capita spending for dental care jum ped five dollars per person in 1981. Over the rem ainder of the decade, however, per capita spending increased less than one dollar, from $79.50 to $80.40; between 1981 and 1984 and again in 1989, per capita spending for dental care actually decreased. Per capita personal health care expenditures, in comparison, rose almost $249 during the 1980s, from $1,163 to $1,412, and increased $197 during the 1982-89 period. Although m ore people are seeing the dentist and the absolute num ber of dental visits has
increased dramatically, spending for dental care has not kept pace with total spending for personal health care. In effect, dental services are consum ing a progressively sm aller portion of a growing personal health care pie. This may be the logical outcome of recent trends in dentistry in the United States: during the 1980s, the general oral health of the nation improved, caries rates declined and dentists were spending a decreasing am ount of time on more expensive restora tive dentistry and an increasing am ount of time perform ing comparatively less expensive diagnostic and preventive procedures. ■ Mr. Bentley is research an aly st II, ADA Bureau of Econom ic a n d B ehavioral R esearch. Detailed expenditure tables a re available from Mr. Bentley.